Russo, Carol K

Russo, Carol K is an individual health care provider with primary practice located at 1107 48Th Ave N Suite 111-E, Myrtle Beach SC 29577-5443. She recently has only one registered license in Behavioral Health & Social Service Providers / Marriage & Family Therapist, which is considered as her primary health care specialty. Russo, Carol K can be contacted via phone (843) 254-9447.

Contact Information

Primary practice address
1107 48Th Ave N Suite 111-E Myrtle Beach SC 29577-5443
Phone: (843) 254-9447
Fax: (843) 449-8753
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Marriage & Family Therapist 106H00000X 4054 South Carolina
Behavioral Health & Social Service Providers / Marriage & Family Therapist 106H00000X 1120 North Carolina

Profile Details

NPI number 1346439742
LBN Legal business name Russo, Carol K
Credentials LMFT
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 22nd, 2007
Last updated Feb 1st, 2008 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1346439742 NPPES
North Carolina MEDICAID 6105147

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